asthma question ....

Ds has recurrent lung problems and has recently been diagnosed with asthma.

He has had a chesty cough for months, no infection, but keeping him up at night. Gp last week said his lungs sounded full of inflammation, but his O2 levels were at 96. He told us to double his Clenil (to 4 puffs am and pm). A week later and he is still needing several puffs of blue inhaler daily - 6 yesterday, 4 today (given at school) and is still coughing well.

Doubling isn't recommended for managing exacerbations or episodes of illness, but can be used in initial dosing to find an optimum regimen.

For example if he's on Clenil 50, you'd normally give 2 puffs twice daily ie 200 mcg total each day. But if he's no better you'd go up to 400mcg daily ie 4 puffs twice daily, and then review, then increase to 800 mcg if needed. You want to get on top of the inflammation but this can take a good 2-3 weeks; obviously if he's worse or his oxygen levels drop you'd take him back and they may give oral steroids (prednisolone).

I'd give it another week or two (depending how he is of course - if he's improving, great, if deteriorating, go back) and give him his salbutamol (ventolin - blue inhaler) every 4 hours, 2 puffs (one at a time but in pairs) up to 10 puffs, through a large volume spacer. If he's still needing 8-10 puffs every 4 hours to stop the coughing then see someone sooner, OOH if necessary.